RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1201091 SEPARATION DATE: 20020307 BOARD DATE: 20121205 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (71L/Administrative Specialist), medically separated for chronic bilateral foot pain secondary to plantar fasciitis with underlying congenital condition of pes planus. The CI reported experiencing bilateral heel/foot pain in early 2000. She was placed on temporary profiles, provided with orthotics, and treated with physical therapy and non-steroidal anti-inflammatory drugs (NSAIDs). She was then evaluated and treated by Podiatry, but continued to experience foot pain. Her bilateral foot pain condition could not be adequately rehabilitated and she was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). Tension headaches and hypertension conditions, identified in the rating chart below, were also identified and forwarded by the MEB. The Physical Evaluation Board (PEB) adjudicated the chronic bilateral foot pain secondary to plantar fasciitis condition as unfitting, rated 0%. The PEB identified the underlying congenital condition of pes planus but did not deduct for the final disability rating. The rating was adjudicated with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting. The CI made no appeals, and was medically separated with a 0% disability rating. CI CONTENTION: “Hypertension, Plantar Fasciitis, Tension Headache.” SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings for unfitting conditions will be reviewed in all cases. The hypertension and tension headache conditions as requested for consideration meet the criteria prescribed in DoDI 6040.44 for Board purview; and, are addressed below, in addition to a review of the ratings for the unfitting chronic bilateral foot pain secondary to plantar fasciitis condition. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records. RATING COMPARISON: Service PEB – Dated 20020117 VA (4 Mos. Post-Separation) – All Effective Date 20020308 Condition Code Rating Condition Code Rating Exam Chronic Bilateral Foot Pain Secondary to Plantar Fasciitis with Underlying Congenital Condition of Pes Planus 5399-5310 0% Bilateral Plantar Fasciitis 5299-5279 10% 20020709 Hypertension Not Unfitting Hypertension 7101 10% 20020710 Tension Headaches Not Unfitting Tension Headaches 8199-8100 0% 20020718 .No Additional MEB/PEB Entries. Not Service-Connected x 5 Combined: 0% Combined: 20% ANALYSIS SUMMARY: Chronic Bilateral Foot Pain Secondary to Plantar Fasciitis with Underlying Congenital Condition of Pes Planus Condition. The narrative summary (NARSUM) notes a year history of bilateral heel pain unrelieved by therapy and inserts (orthotics). Pain was increased with prolonged standing or walking. Examination of the feet, 3 months prior to separation, indicated normal vascular, skin, neurologic and muscle strength exams. “The patient has noted pes planus bilaterally that is asymptomatic.” There was bilateral pain on palpation at the plantar, medial, calcaneal tubercles bilaterally that increases with dorsiflexion. Range-of-motion (ROM) of the ankle and foot was normal (“… patient has full range of motion in all ankle and pedal joints bilaterally.”) Radiographs documented small bilateral Achilles spurs and bilateral os trigonum (small uncommon sesimoid bone behind the ankle). The CI’s entry physical in 1996 documented normal arches. At the VA Compensation and Pension (C&P) exam performed 4 months after separation, the CI reported episodic numbness in the feet, pain in the heels, and increased pain with inserts. Gait was slow with complaint of heel pain. Exam documented normal skin and “bilateral heel pad tenderness compatible with plantar fasciitis.” The examiner stated “She does not have pes planus.” The Board directs attention to its rating recommendation based on the above evidence. There is no specific VASRD code for plantar fasciitis and rating must be accomplished analogously. The PEB coded the condition analogous to 5310, Group X muscles at 0% (slight). They formally considered the congenital pes planus and mad no deduction (“EPTS Factor: UND”). The VA did not find any evidence of pes planus and rated the bilateral plantar fasciitis at 10% with analogous coding to 5279 [Metatarsalgia, anterior (Morton’s disease), unilateral, or bilateral] at 10%. Analogous coding under 5310 would be for each foot separately and must follow the provisions of VASRD §4.73 (Schedule of Ratings-Muscle Injuries) and both §4.55 (Principles of combined ratings for muscle injuries) and §4.56 (Evaluation of muscle disabilities) which focus on traumatic muscle injuries. Analogous coding under 5276 [Flatfoot, acquired: (pes planus)] was not supported by the evidence of the treatment record, the VA exam showing no pes planus, or with consideration of §4.57 (Static foot deformities). The Board considered the CI's underlying pathology, functional limits and bilateral foot tenderness with painful motion not responsive to prolonged therapy would warrant alternative analogous coding to 5279 (5299- 5279). After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic bilateral foot pain secondary to plantar fasciitis with underlying congenital condition of pes planus condition. Contended PEB Conditions. The contended conditions adjudicated as not unfitting by the PEB were hypertension and tension headaches. The Board’s first charge with respect to these conditions is an assessment of the appropriateness of the PEB’s fitness adjudications. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. None of these conditions were profiled; none were implicated in the commander’s statement; and, none were judged to fail retention standards. All were reviewed by the action officer and considered by the Board. There was no indication from the record that any of these conditions significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended hypertension or tension headache conditions; and, therefore, no additional disability ratings can be recommended. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the chronic bilateral foot pain secondary to plantar fasciitis with underlying congenital condition of pes planus condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5279 IAW VASRD §4.71a. In the matter of the contended hypertension and tension headache conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation: UNFITTING CONDITION VASRD CODE RATING Chronic Bilateral Foot Pain Secondary to Plantar Fasciitis with underlying congenital condition of Pes Planus 5299-5279 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120603, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record XXXXXXXXXXXXXXXXX, DAF President Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / XXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXX, AR20130000150 (PD201201091) 1. I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation. This decision is final. 2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum. 3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures. BY ORDER OF THE SECRETARY OF THE ARMY: Encl XXXXXXXXXXXXXXXXXXX Deputy Assistant Secretary (Army Review Boards)